Ohio Community Paramedics Reduce ER Visits, Improve Patient Care

The Columbus Dispatch, Ohio

Dec. 27—Though he's a paramedic by trade, Randy Jones spends his work days scheduling doctor appointments, loading pill dispensers and educating Whitehall residents about their medical conditions.

His job isn't to respond to emergencies anymore. It's to do his best to prevent them from happening in the first place.

For nearly a year, Jones has served as Whitehall's community paramedic—a new job that is gaining popularity in fire departments throughout central Ohio.

The specially trained paramedics meet with residents in non-emergency situations to solve the issues that cause them to frequently dial 911 for help, often for non-emergencies. They work alongside other health-care providers, including home health staff, and fill in any gaps in care that may be present.

The goal is to keep residents safe and healthy in their homes, while also saving time and resources for hospitals and fire departments.

Whitehall residents can call Jones and ask for a home visit. Other paramedics can also refer patients to him if they spot a health or safety issue and the resident is willing to let them intervene.

"We talk about fire prevention all day, every day, and nobody bats an eye," said Jones, a paramedic of 17 years. "This is the same concept—but it's emergency prevention."

Some residents may need help preparing meals and administering insulin to control their diabetes. In other homes, clutter could be causing an older person to fall.

Jones has also referred patients dealing with addiction and substance abuse to treatment centers.

One success story is 69-year-old Maxine Welch, who credits Jones with curbing her high blood pressure by helping her understand the two-dozen or so prescription pills she takes daily for multiple health issues.

He created a chart detailing her medicines and synced it to a timed dispenser that he fills regularly. Whenever an alarm sounds, the device releases her prescriptions and Welch knows it's the correct time to take them.

Jones also talked with Welch's many specialists and provided them the chart to ensure they weren't prescribing any conflicting medications.

Before the intervention, Welch called an ambulance to her Beechbank Road home dozens of times yearly.

Now she's taking fewer medications and her health has improved.

Jones usually visits two or three times a week, such as last Monday, when he added Robitussin to her regimen to battle a severe cold. He also helped program her electronic Bible so she could listen to scripture passages, because she has difficulty seeing and can't always read them.

"It makes my day when you visit," Welch told Jones, reaching for a hug.

Without Jones, it's very possible Welch could've been put in a nursing home, said Julie Burns, her mental-health nurse.

Whitehall's program began through a partnership of Truro Township, Violet Township and Mount Carmel Health. The hospital system's foundation donated $45,000 to get it started and trained its participants. Starting next year, doctors also will begin referring potential patients to the community paramedics.

Mount Carmel St. Ann's hospital is hosting a forum on the topic in late January and about 20 central Ohio fire departments are expected to attend.

A change in state law in 2015 made the emerging practice possible.

Before that, it was illegal for Ohio paramedics to visit a person's home if they weren't called to respond to an emergency.

Other states have had successful programs for years, which inspired local departments to consider the idea once it became an option, Whitehall Fire Chief Preston Moore said.

Jones is now serving about 20 full-time patients and has had about 90 referrals from fellow paramedics.

Though funding can be a roadblock for some departments seeking a full-time community paramedic, Moore said he was fortunate Whitehall officials saw the potential and paid for it. It's cost about $175,000 to get the program started.

Each arrangement can be modified to reflect a community's needs.

Upper Arlington launched a part-time pilot program this year called CARES, which stands for Community Assistance, Referrals and Education Service, that offers in-home CPR and AED training, medical assessments, and "safe baby" training for new parents, among other things. A fee often offsets the costs.

Upper Arlington Deputy Fire Chief Mark Zambito hopes a community paramedic can address needs targeted by Stay UA, a city program to help older residents stay in their homes.

The fire department has partnered with Dr. Carmen Quatman, a geriatric-focused orthopedic surgeon from Ohio State University's Wexner Medical Center, to specifically address preventing injuries caused by falling.

A community paramedic can serve as eyes and ears for health-care providers, monitoring patients' living conditions, diets and baseline health at home in a way they can't during office visits, Quatman said.

The practice could change the entire landscape of health care, she said.

"In our current system, when a patient is dropped off at the emergency room, the transport team has no idea what happens to the patient," Quatman said. "Community paramedics can close the loop and provide an entire spectrum of care."